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LATEST NEWS UPDATES | Health insurance firms are denying us coverage, some organ donors allege -Priyanka Vora

Health insurance firms are denying us coverage, some organ donors allege -Priyanka Vora

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published Published on Jan 28, 2018   modified Modified on Jan 28, 2018
-Scroll.in

Doctors say that this could discourage others from donating their organs.

In 2009, Dr Ravi Wankhede, a pathologist and resident of Nagpur, donated one of his kidneys to a friend. Wankhede saved his friend’s life but his altruism might have cost him his health insurance.

When Wankhede turned 65 two years ago, his health insurance company told him that his policy could not be renewed because the company does not cover people older than 65. Assuming that this was common practice, Wankhede approached another private company, which specifically has health insurance for elderly people. To his dismay, this company also rejected his request. Wankhede believes that the company refused him insurance because he now has only one kidney.

“I got a reply which said ‘was rejected as per guided by our underwriting policy that endeavors to group individuals who exhibit homogeneous risk profiles’,” said Wankhede. “I had disclosed in my application that I was a kidney donor, which worked against me.”

Health insurance companies conduct health screenings of prospective clients, who have to disclose all known pre-existing medical conditions and answer questions about their lifestyles. This information is used to evaluate the application for health coverage – a process called medical underwriting – to calculate the chances that the person being insured filing a claim over a period of time, on the basis of which the application is rejected or accepted and the insurance premium calculated.

The companies create risk pools, which are groups of people whose predicted claims are combined in order for underwriters to calculate premiums at a rate that is meant to allow the company to pay claims while making a profit. This means the costs are effectively shared by all members of the pool, and the claims made by the less healthy are subsidised by the relatively fewer claims made by the healthy.

Scroll.in contacted Cigna TTK about why Wankhede’s proposal was denied. “The customer’s proposal was not accepted as per the filed underwriting guidelines. As per our policy we do not disclose confidential customer information,” a company spokesperson responded by email. While the insurance company has refused to clarify what it means by “homogeneous risk profile”, it seems that it judged that including Wankhede in the group could lead to higher insurance payouts.

A third insurance company rejected Wankhede’s application for health insurance without even asking for his medical tests. Wankhede had disclosed in this application that he had donated a kidney.

Wankhede has registered complaints with the companies he applied to for insurance as well as with the Insurance Regulatory and Development Authority of India contending that he has been denied insurance because of discriminatory policies against organ donors. He has not received responses to any of his complaints.

When Scroll.in repeatedly tried to contact TS Vijayen, the chairman of the Insurance Regulatory and Development Authority of India, about Wankhede’s complaint, he refused to comment.

Please click here to read more.

Scroll.in, 27 January, 2018, https://scroll.in/pulse/866499/health-insurance-firms-are-denying-us-coverage-some-organ-donors-allege


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